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KansasTelemedicineandAdvancesinTele‐Pediatrics

RyanSpaulding,PhDViceChancellor,CommunityEngagementDirector,CenterforTelemedicine&TelehealthAssociateProfessor,HealthPolicy&Management

Disclosure• Ihavenorelevantfinancial

relationshipswiththemanufacturers s ofanycommercialproducts s and/orproviderofcommercialservicesdiscussedinthisCMEactivity

• Idonotintendtodiscussanunapproved/investigativeuseofacommercialproduct/deviceinmypresentation.

PreviewofPresentationI. NationalOverview

I. StatusII. Trends

II. KansasTelemedicineI. ExamplesII. ReimbursementIII. Medico– Legal

III. Tele‐PediatricsI. School–basedII. AutismSpectrumIII. UCDavisIV. Otherissues

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Definitions

Telemedicine– videoconsultation Telehealth– “storeandforward”asynchronousimagesordata

DistantSite– providerlocation OriginatingSite– patientlocation mHealth– mobilehealth “apps”– smartdeviceapplications

NationalOverview Currenttelemedicinemovementbeganinlate1980’s Moststateshaveatleastonetelemedicineprogram,ofteninuniversitymedicalcenters

32%ofthe4,727reportinghospitalsuseatleastonetypeoftelehealth service HIMSS

Over100,000iOSandAndroidhealthcareapps ModernHealthcare

AmericanTelemedicineAssociationwww.americantelemed.org

mHealthSummitwww.mhealthsummit.org

StateswithMedicaid/PrivateCoverage

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Telehealth“Parity”Legislation

NationalObservations

Healthsystems;privatesector Reducedsystemutilizationasdrivers Home orotherprivate setting Patientinitiated Specialtycaretoprimarycare Mobile,smartdevices,wearable Interstate

KansasTelemedicineExperience

Firstimplementedin1991withonehospital Primarilyfacilitatedbyinteractivevideoconference Programhasexpandedintomorehospitals,schools,nursinghomes,andclinics Cardiology,mentalhealth,oncology,pediatrics,manyothers

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Mobile,multi‐pointconnectionwithadditionalcliniciansorotherstakeholders

TELEPRESENCEROOM

TABLET

SMARTPHONE

HomeParenteralNutrition

• BypassestheGItractinboweldisease

• LifelongtwicedailyInfusionofsolutionsviapumpinhome

• Riskofinfectionsandcomplications

• Currentstudywith80familiesinU.S.

• RNsobservecarefromadistance

• Limitssociallife,work,meals;depressioncommon

Research reported in this presentation  was supported by the National Institute Of Biomedical Imaging And Bioengineering of the National Institutes of Health under Award Number R01EB015911. C. Smith, PhD RN  Principle Investigator.  The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.”

Creating a Wireless Infrastructure 11

AdditionalKansasProjects

TeleStroke KUHospital TeleED KUHospital PediatricEpilepsy KUMC KansasECHO KUMC

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KansasECHO• “ExtensionforCommunity

HealthcareOutcomes”• Primarycare,case‐based

presentationstospecialtyteamusingtechnology

• PioneeredinNewMexico• Supportsruralpractices’

managementofchronicconditions

• CEprovided• Somereimbursement• Kansasimplementation

early2015– painmanagement

• Photo courtesy of ECHO and The Pain Practitioner, Vol 21, #2, p. 61

ThereisReimbursement!

Medicare 2001 KansasMedicaid 2004 Mostlarge,privateinsurersinKansas mid‐2000’s BlueCross/BlueShieldofKansaswasoneoffirstinsurersinnationtocovertelemedicine1995

KMAP 90791GT 90832GT– 90838GT 90847GT 90863GT 99201GT‐ 99205GT 99211GT‐ 99215GT 99261GT‐ 99263GT 99271GT‐ 99275GT

H0001GT H0004GT H0005GT H0006GT H0007GT H0038GT H0038HQGT

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Medico‐ Legal

CredentialingandPrivileging

Licensure

Malpractice

GenerallyTreatedsameasOutreach

Wherepatientislocatedisplaceofservice Providersneedtobecredentialed/privileged/licensedateachplace/stateofservice TJCandCMSnowbothallowcredentialingbyproxy Standardmalpracticeinsurancecoverstelehealth Verylowriskservicetodate Nationalefforttocreatetelemedicinelicense

Advances in Tele – Pediatrics 

TeleKidcare

Implemented 1997 with 4 Kansas City, KS schools; 12 at peak

Primarily for urgent care with KUMC peds

Evolved to more mental health

New programs in New York and North Carolina 

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AdditionalPeripherals

Stethoscope Dermascope Ophthalmascope Generalexamcamera Handheldretinacamera IntegrationofperipheralswithP.C.

AutismSpectrumService

TrainexistingAutismInterdisciplinaryTeams AIT andPartCNetworkteamsintheassessmenttoolsusedtodiagnoseautism

TeamscollecttheinformationandwritetheirfindingstopasstoalocalphysicianorCCHDteamviatelemedicinewhodetermineaDiagnosticImpression.

GOAL:Fromreferraltodiagnosis,childrenandfamiliesareseenin45days Currently,await‐timeattheavailablediagnosticclinicsvariesfrom3monthsto1year.

AutismTelemedicineServices

FortheDiagnosticImpression,teamsconnecttoCCHDstaffviatelemedicine

Thefamily,theschoolorPartCnetwork,andCCHDstaffmeettodiscusstheassessmentfindings,clarifytheinformation,discussmedicalhistory,andmakeaDiagnosis. Appointmentsare45minuteslong TelemedicinesitesthroughoutthestateusingITVnetwork

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UC Davis Telemedicine Connecting to 120 sites/year >40,000 total consults to date >6,000 pediatric consults to date Applications at UC Davis Outpatient services Interpretation of studies ED services (stroke, trauma, ICU) Inpatient ward, ICU, NICU Remote Patient Monitoring (RPM) Training, Mentoring, Education Use by Advanced Practice Provider

Interpretation of Studies Tele-radiology:

standard of care Tele-dermatology Cardiac ultrasound

– Cyanotic Congenital Heart Disease Screening

EEG interpretation Screening for retinopathy Tele-psychiatry, behavioral health

Pediatric Critical Care Telemedicine Network

As of 5-2014: 27 EDs3 Inpatient wards4 Nurseries2 ICUs

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Telehealth: Leveraging Technology to Provide Patient Centered,

High Quality, and Cost-Effective Care

Jim Marcin UC Davis Children’s Hospital Sacramento, CA jpmarcin@ucdavis.edu 916-734-4726

PracticeParameterforTelepsychiatrywithChildrenandAdolescentsfromAmericanAcademyofChildandAdolescentPsychiatry

Principle Definition Brief Description

1 Theneedforchildandadolescentpsychiatricservicesandwhethertelepsychiatry isanoptionformeetingthatneedshouldbedetermined.

Theclinicalneedshoulddrivetheservice,notthetechnologyorsomeotherpurpose.Aproposedservicethatdoesnotoriginatewithaclinicalneedisdoomedtofailure.Moreover,theadvantages,disadvantages,communitysupport,infrastructureandotherissuesshouldbefullyreviewedbeforeimplementation.

2 Thesustainabilityofthetelepsychiatryserviceshouldbedetermined.

Thoughsustainabilitycanbelooselydefined,someongoingsupportoftheprojectwillbeneeded.Someprogramshavechosentofundoperationsthroughcontinuousresearchfundingsupport,whileothershavedecidedtomaximizerevenueorcostsavings.Whateverthemechanism,thisdecisionshouldbemadeearlyintheproject.

3 Thepatientpopulation,themodelofhealthservicedelivery,andservicestobeofferedshouldbedetermined.

CloselyrelatedtoPrinciple1butalsoinvolvesmorespecificdetailsaboutpatientinclusioncriteria,itemizedservicesandconsultationversustherapeuticresponsibilitiesofthepsychiatrist.

HIPAAIssues InteractivetelemedicinenotgovernedbyHIPAA NotconsideredPHI NotrecordedorstoredlikeotherPHI HIPAAdoesnotrequireencryption butweencrypt Useprivateconnectionswhenpossible Telemedicineroomshouldbeprivatejustlikeanyotherclinicroom Emergingopinionsonmobiledevices

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HealthReform&Telemedicine

Handfulofdirecttelehealthprovisions Mostlyindirectviaquality,capitationorcarecoordination 30dayreadmissionrule ConcurrentwithNationalBroadbandPlan MostsignificantindirectisCMI

CreatednewCMSCenter

CenterforMedicareandMedicaidInnovationCMI

Testbothpaymentanddeliverymodels Fundedat$10billion HealthCareInnovationChallenge HCIC AnnouncedNovember2011 $1billion $1millionto$30millionawards Reportedly100,000lettersofintent

ACAalsodirectsCMIto…

“Facilitateinpatientcare,includingintensivecare,ofhospitalizedapplicableindividualsattheirlocalhospitalthroughtheuseofelectronicmonitoringbyspecialists,includingintensivistsandcriticalcarespecialists,basedatintegratedhealthsystems;”

eICUmodel

Americantelemed.org

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OtherMedicareProvisionsforTelehealth

IncludesuseofremotemonitoringforeligiblemedicalpracticesintheIndependenceatHomeDemonstrationProgram

Allowsphysicianstousetelehealth tocertifytheneedforhomehealthservicesordurablemedicalequipment

AllowstelehealthtechnologiestobeusedbyapharmacistorotherqualifiedproviderinperforminganannualcomprehensivemedicationreviewofMedicaredrugplanmedicationtherapymanagementprogramsaswellasneededfollow‐upinterventions.

ForthenewCommunity‐BasedCollaborativeCareNetworkProgram,thelegislationrecognizestheroleoftelehealth toexpandingtheprogram’scapacity

Americantelemed.org

30dayreadmission

CMSauthorizedtopenalizebeginningin2013 CHF,AMI,pneumonia 2015,COPD,bypass,percutaneousintervention,othervascularsurgeryprocedures Hometelehealthorotherremotemonitoringforpost‐dischargeperiod

Medicaid… legislationprovidesa“healthhome”optionforchronicconditionsthatincludes:

“aproposalfortheuseofhealthinformationtechnology inprovidinghealthhomeservices…andimprovingservicedeliveryandcoordinationacrossthecarecontinuum includingtheuseofwirelesspatienttechnologytoimprovecoordinationandmanagementofcareandpatientadherencetorecommendationsmadebytheirprovider ”

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Future Courtesyofmhealthwatch.com

The Telehealth Resource CenterGrant Program

www.telehealthresourcecenters.org

Technical assistance forstarting or expanding telehealth services.

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HTRC SERVICE AREA

KANSAS ‐ MISSOURI ‐ OKLAHOMA

RyanSpaulding913.588.2251

rspaulding@kumc.edu